Modifications of Laparoscopic Cholecystectomy

Abstract

Aims: More than 30 different ways of performing laparoscopic cholecystectomy (LC) are described in the literature. These were developed by surgeons with the aim to improve postoperative and esthetic outcome following LC. The modifications included reduction in port size and/or number than what is used in standard LC. The aim of this literature review was to evaluate the technical feasibility of the modifications of LC without compromising safety and the benefits associated with these modifications in terms of safety, postoperative pain, cosmesis, early recovery, and patient satisfaction. Materials and methods: Literature review was performed on articles describing different techniques of LC, variations in port number and size, and their advantages over one another. The search was made by using search engines like Google, PubMed, Springer link, and HighWire Press. Observation: Reduction in number of ports and port size especially in epigastric site gave advantages in terms of decreased postoperative pain score and esthesis. There was an increase in the number of transumbilical single-site surgery (TUSS) being performed in recent years with advantages like decreased postoperative pain and increased patient acceptance being documented in various studies. Hybrid technique of using additional ports during single-site laparoscopic surgery (SSLS) may be used as a bridge to single-site surgery while the surgeon is in a learning curve from a multiport surgery to SSLS. Currently NOTES cholecystectomy is under evaluation and not routinely performed. But current literature does not provide enough evidence of any clear benefit of any of these modifications over standard LC. Conclusion: This literature review showed that even though there are some advantages in postoperative pain score, esthetic outcome, and patient acceptance while doing the different types of LC in selected patients, there is no evidence of any clear benefit over conventional LC. It is not acceptable to compromise the vision and increase the risk of bile duct injury to the patient while doing LC. Hence, modified LC may be performed by surgeons only after gaining enough experience and in selected group of patients without violating the basic principles of laparoscopic surgery.